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Affidavit of Loss Plate

1. The affidavit details the loss of a vehicle license plate belonging to an individual. It provides details of the vehicle such as make, motor and chassis numbers. 2. The plate was lost when the vehicle was parked and the owner noticed it was missing upon returning. Despite efforts, the plate was not recovered. 3. The owner swears the plate was not lent to others and was truly lost. They agree to surrender the plate if recovered and accept penalties if misuse is found. 4. The purpose of the affidavit is to request a replacement plate or for vehicle transfer/sale procedures.

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gershwin gavanes
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198 views1 page

Affidavit of Loss Plate

1. The affidavit details the loss of a vehicle license plate belonging to an individual. It provides details of the vehicle such as make, motor and chassis numbers. 2. The plate was lost when the vehicle was parked and the owner noticed it was missing upon returning. Despite efforts, the plate was not recovered. 3. The owner swears the plate was not lent to others and was truly lost. They agree to surrender the plate if recovered and accept penalties if misuse is found. 4. The purpose of the affidavit is to request a replacement plate or for vehicle transfer/sale procedures.

Uploaded by

gershwin gavanes
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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REPUBLIC OF THE PHILIPPINES )

PROVINCE OF LAGUNA )
CITY OF CALAMBA )SS

AFFIDAVIT OF LOSS PLATE

I, __________________________________, of legal age, Filipino and a residence of


__________________________________________________, after being sworn to in accordance with law, hereby
depose and say, THAT:

1. I am the registered owner/operator of the motor vehicle described as follows:


Make/Type : __________________ C.R. No. :___________________
Motor No. : __________________ OR No. : __________________
Chassis No. : __________________ File No. : __________________
Plate No. : __________________ Classification : __________________

2. On __________,20__, my vehicle was properly parked at _____________________. When I returned


to retrieve the above-described vehicle on ________________, I noticed that one/both of its plates
is/are missing:

3. I lost no time in diligently trying to locate the said plate/s but all efforts exerted proved futile and to
no avail, and that the same is considered lost stolen and beyond recovery:

4. The said lost plate/s was/were never lent to another person or entity nor confiscated by any other
law enforcement agency or has no pending or unresolved case for apprehension, alarm, suspension
or revocation;

5. I bind myself to surrender the said plates to the district office that issued the same in the event that
said plates are recovered;

6. If the DOTC thru the LTO/LTFRB, after inquiry, has found me responsible for the unauthorized use of
the herein reported loss plates, I hereby signify my conformity to be meted the administrative fines
and penalties due and imposed thereon, including the grounding of the unit/s covered by the
Certificate of Public Convenience issued therefore, with the waiver and desistance on my part for any
action by reason of the aforesaid punitive measures taken against me.

7. Purpose of this Affidavit of Loss:

/_/ For LTFRB Petition for Dropping and Substitution


/_/ For LTFRB Petition for Sale and Transfer, and /or
/_/ For securing a replacement for lost plates
8. I am executing this affidavit for the aforesaid purpose/s as well as for attesting to the truth of the
statements herein declared, subject to the rules on perjury.

AFFIANT FURTHER SAYETH NAUGHT.

________________________________

Affiant

SUBSCRIBED AND SWORN to before me this ______ day of ________________ in the year of
Our Lord, ______, in the City of Calamba, Province of Laguna, Philippines affiant exhibited before me his
Driver’s License No. _____________________ as evidence of identity.

Doc. No.
Page No.
Book No.
Series of 2012

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